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Background: To eliminate cervical cancer in Canada by 2040, defined as an annual age-standardized incidence rate (ASIR) lower than 4.0 per 100 000 women, the Canadian Partnership Against Cancer (CPAC) identified 3 priorities for action: increasing human papillomavirus (HPV) vaccine coverage, implementing HPV-based screening and increasing screening participation, and improving follow-up after abnormal screen results. Our objective was to explore the impact of these priorities on the projected time to elimination of cervical cancer in British Columbia., Methods: We used OncoSim-Cervical, a microsimulation model led and supported by CPAC and developed by Statistics Canada that simulates HPV transmission and the natural history of cervical cancer for the Canadian population. We updated model parameters to reflect BC's historical participation rates and program design. We simulated the transition to HPV-based screening and developed scenarios to explore the additional impact of achieving 90% vaccination coverage, 95% screening recruitment, 90% ontime screening, and 95% follow-up compliance. We projected cervical cancer incidence, ASIR, and year of elimination for the population of BC for 2023-2050., Results: HPV-based screening at current vaccination, participation, and follow-up rates can eliminate cervical cancer by 2034. Increasing on-time screening and follow-up compliance could achieve this target by 2031. Increasing vaccination coverage has a small impact over this time horizon., Interpretation: With the implementation of HPV-based screening, cervical cancer can be eliminated in BC before 2040. Efforts to increase screening participation and follow-up through this transition could potentially accelerate this timeline, but the transition from cytology- to HPV-based screening is fundamental to achieving this goal., Competing Interests: Competing interests:: Laurie Smith is a member of working groups for nonprofit organizations and acts as a consultant for a federally funded nonprofit organization. Anna Gottschlich reports a grant from Michael Smith Health Research BC. Gina Ogilvie receives grant funding from public sector and not-for-profit entities; she does not receive industry funding. She sits on the board of many health-related not-for-profits. No other competing interests were declared., (© 2024 CMA Impact Inc. or its licensors.)

Background: Although cancer screening has led to reductions in the incidence of invasive cervical cancer (ICC) across Canada, benefits of prevention efforts are not equitably distributed. This study investigated the sociodemographic characteristics of women with ICC in British Columbia compared with the general female population in the province., Methods: In this descriptive study, data of individuals 18 years and older diagnosed with ICC between 2004 and 2013 were obtained from the BC Cancer Registry. Self-reported sociodemographic characteristics were derived from standardized health assessment forms (HAFs) completed upon admission in the BC Cancer Registry. Standardized ratios (SRs) were derived by dividing observed and age-adjusted expected counts by ethnicity or race, language, and marital, smoking and urban-rural status. Differences between observed and expected counts were tested using χ 2 goodness-of-fit tests. General population data were derived from the 2006 Census, 2011 National Household Survey and 2011/12 Canadian Community Health Survey., Results: Of 1705 total cases of ICC, 1315 were referred to BC Cancer (77.1%). Of those who were referred, 1215 (92.4%) completed HAFs. Among Indigenous women, more cases were observed ( n = 85) than expected ( n = 39; SR 2.16, 95% confidence interval [CI] 2.15-2.18). Among visible minorities, observed cases ( n = 320) were higher than expected ( n = 253; 95% CI 1.26-1.26). Elevated SRs were observed among women who self-identified as Korean (SR 1.78, 95% CI 1.76-1.80), Japanese (SR 1.77, 95% CI 1.74-1.79) and Filipino (SR 1.60, 95% CI 1.58-1.62); lower SRs were observed among South Asian women (SR 0.63, 95% CI 0.62-0.63). Elevated SRs were observed among current smokers (SR 1.34, 95% CI 1.33-1.34) and women living in rural-hub (SR 1.29, 95% CI 1.28-1.31) and rural or remote (SR 2.62, 95% CI 2.61-2.64) areas; the SR was lower among married women (SR 0.90, 95% CI 0.90-0.90)., Interpretation: Women who self-identified as visible minorities, Indigenous, current smokers, nonmarried and from rural areas were overrepresented among women with ICC. Efforts are needed to address inequities to ensure all women benefit from cervical cancer prevention., Competing Interests: Competing interests: None declared., (© 2021 CMA Joule Inc. or its licensors.)

Relationship violations have been documented in all service professions, particularly those involving a power differential in the relationship. Although the coach-athlete relationship is not a typical therapeutic interaction, there should be professional and ethical boundaries. Boundary violations, including sexual abuse of a minor, do occur. Five clinical cases of relationship disturbances are presented. The authors use the paradigms of transference, countertransference, and achievement by proxy distortion to discuss these worrisome vignettes. Colleagues are encouraged to collaborate in an effort to develop awareness and prevention programs through research and education. Developing an enlarged workbook of similar case studies for use as a stimulus for seminars and discussions in training environments is an immediate goal.

The role of the sport psychiatrist consulting to a professional sports team is complex, challenging, and varied. Sport psychiatrists enhance the psychosocial development of the athlete by removing obstacles to growth and by facilitating lines of communication that support exchange of information, sharing of feelings, and the development of solid winning relationships on the team and throughout the organization. The consultant psychiatrist often provides input both to players and to management, however; these dual responsibilities raise ethical concerns and often require the services of additional treating psychiatrists and other mental health professionals.

Background: Complete repair of infants with interrupted arch and ventricular septal defect through a midline incision has been the preferred method for more than 20 years. End-to-end anastomosis can result in restenosis if there is excess tension. Two methods of reducing this tension have been described, and the subsequent growth of the new aortic arch is demonstrated., Methods: In 2 infants (5 and 9 months old) the duct was used to create a new aortic arch. In 3 other younger infants the left carotid artery was divided, turned down, and anastomosed to the descending aorta to form the new arch. These operations were performed through the midline at the same time as the ventricular septal defect was closed., Results: All 5 patients are well now 8 to 19 years postoperatively. One patient required reoperation for stenosis at the anastomotic site, but all have subsequently shown good growth on follow-up angiographic and magnetic resonance imaging studies., Conclusions: Although end-to-end repair is best, these alternative methods have shown very satisfactory aortic growth into adult life.

We report a unique case of cardiac tamponade in a newborn due to an intrapericardial lymphangioma. Echocardiography and magnetic resonance imaging suggested that the mass, which was situated between the right atrium and the aortic root, was unsuitable for primary resection. A pericardial window was performed, and over the next 16 months the tumor spontaneously regressed.

A variety of approaches and surgical techniques have been described for the management of recurrent coarctation. When there is an additional intracardiac defect that requires surgical correction it is preferable to correct both lesions simultaneously and through the same incision. This article reports two new techniques of connecting ascending to descending aorta using an intrathoracic conduit and performed through a median sternotomy.

Climbing may be considered appropriate for the older athlete. The requisites, cardiovascular and musculoskeletal fitness, can be attained through training; the skills can be acquired through schools or guide services. Inherent risks can enhance the enjoyment. The motivational psychology for climbing usually reflects positive qualities and attitudes toward life and the environment. With good health, the recreation of climbing can be enjoyed well into the seventh decade of life. Climbing may not be for everyone, but the physical and physiologic benefits, as well as the challenges, are available to the older athlete.

Nine cases of delayed presentation of diaphragmatic hernia secondary to blunt trauma are presented. The delay in presentation varied from one to 16 years from the time of the original injury. The chest radiography was abnormal in all cases. In some, herniation could be reasonably inferred but in others there were only non-specific signs. Once the diagnosis of delayed presentation of traumatic diaphragmatic hernia is suspected, we have found barium studies to be the most useful confirmatory investigations.

Teams occasionally win successive national championships, but it hasn't happened very often in recent years. The explanation may lie in the peculiar psychology of winning.

Eight balloon dilatations were performed in five patients (aged from 10 to 37 months) in whom supravalvar pulmonary stenosis developed after anatomical correction for complete transposition. The ratio of the maximum diameter of the inflated balloon to the narrowest pulmonary arterial diameter varied from 1.6 to 3.3. In three patients with an initial ratio of less than or equal to 2 dilatation was repeated with a larger balloon. The right ventricular systolic pressure ranged from 0.70 to 1.25 of the simultaneously measured femoral arterial systolic pressure. The major stenosis was in the main pulmonary artery in four patients and at the pulmonary arterial bifurcation in one. After balloon angioplasty in the four patients there was no significant improvement in the ratio of right ventricular to femoral arterial systolic pressure or in the angiographic appearance. There was no change in the pressure ratio after angioplasty in the patient who had a major stenosis of the pulmonary arterial bifurcation and mild main pulmonary artery narrowing. There seemed to be a slight angiographic improvement in the bifurcation stenosis but at restudy two months later the angiographic improvement had disappeared. Balloon angioplasty of supravalvar pulmonary stenosis developing after anatomical correction for complete transposition was not successful in eight procedures. This lack of success may be attributable to a small pulmonary annulus with consequent multiple levels of stenosis and distortion of the main pulmonary artery.

A study was carried out to determine the accuracy of multiple-gated blood-pool imaging in diagnosing left ventricular aneurysm. Fifteen patients with an aneurysm and 17 with left ventricular hypokinesia were studied by contrast ventriculography and multiple-gated blood-pool imaging. The results of blood-pool imaging were examined blind by five independent observers, the results of contrast ventriculography being used as the standard. The mean sensitivity of the procedure was 56%, the specificity 61%, and diagnostic accuracy 59%. These results indicate that contrast ventriculography remains the best method for diagnosing left ventricular aneurysms. Moreover, ventriculography provides additional information-for example, on wall thickness-not provided by multiple-gated blood-pool imaging.

The qualitative assessement of left ventricular wall motion using a four-point scale has been compared between left ventricular contrast angiography and equilibrium radionuclide angiography in the 30 degrees right anterior oblique projection. Analysis was carried out for five segments of the left ventricle. Four modes of analysis of equilibrium radionuclide angiography were compared and the reproducibility assessed. Overall accuracy of equilibrium radionuclide angiography compared to contrast angiography was greater than 82% to within one degree of motion. One method using a cine display, averaged 97%. We suggest that equilibrium radionuclide angiography using the cine display is the non-invasive investigation of choice in the screening of patients with suspected regional wall motion abnormalities.

Thirty one patients with multiple ventricular septal defects were studied by cross sectional echocardiography, conventional pulsed and continuous wave Doppler, colour flow imaging, and left ventriculography to determine the relative diagnostic benefits and pitfalls of each technique. The patients studied had a wide range of congenital heart defects with 19 patients having isolated multiple ventricular septal defects, three with associated tetralogy of Fallot, five with double outlet right ventricle, three with complete transposition and ventricular septal defect, and one with a complete atrioventricular septal defect. In 23 patients the defects were inspected at operation. Cross sectional imaging with integrated pulsed and continuous wave Doppler correctly identified multiple defects in only 12 (39%) patients. In contrast, colour flow imaging was accurate in 24 (77%) patients and left ventriculography in 20 (65%) patients. When patients were subdivided on the basis of relative peak systolic ventricular pressures into restrictive defects (18 patients) and non-restrictive defects (13 patients) the diagnostic value of colour flow imaging was different for each group. Colour flow mapping correctly identified multiple ventricular septal defects in 16/18 (89%) patients with restrictive defects but only 8/13 (62%) with non-restrictive defects. The comparative diagnostic accuracy of left ventriculography was 15/18 (83%) in the restrictive group and 5/13 (38%) in the non-restrictive group. Colour flow imaging was the single investigative technique with the greatest diagnostic accuracy in the diagnosis of multiple ventricular septal defects. It failed to be consistently accurate in defined subgroups with non-restrictive defects as did left ventriculography. The greatest overall diagnostic accuracy in this series was obtained when both colour flow imaging and ventriculography techniques were used in combination in a complementary fashion.

How does a strong motivation to win affect women after the days of competition are over? Ten years later, these swimmers say it contributed positively to their social health.

Sixty-two children investigated by cardiac angiography for a wide spectrum of congenital heart disease were randomly assigned to one of two groups, one for iohexol, 350 mg I/ml (Omnipaque, Nycomed UK Ltd) and one for iopamidol, 370 mg I/ml (Niopam, E. Merck Ltd). Changes in systolic pressure, end-diastolic pressure when the injection was made into a ventricle, heart rate and rhythm and plasma osmolality were assessed at 1 min and 3 min after the injection of contrast medium. The angiograms were subjectively assessed for angiographic quality. No significant differences were detected between the two groups.

Medical-training institutions must begin to give more than token attention to the near universal stresses that are an integral part of role confusion conflicts in the practice of medicine. Every student should be mentally and emotionally prepared for the negative side of success. There are certainly no guaranteed mentally hygienic methods that will prevent neurotic stress reactions, but heightened awareness as to where the dangers might lie will greatly decrease the incidence of catastrophic reactions. As a final recommendation training institutions must expose their students to behavioral scientists who will win their respect and establish credibility for the healing arts. Based on limited data, 10% of physicians will be in need of a behavioral scientist's counsel by age 45 years.

The results of 3000 consecutive operations using cardio-pulmonary bypass show that the overall early mortality was 6.1%, dropping from 8.9% in the first 1000 to 4.4% in the third 1000. Operations for valve disease have been the most common, the early mortality for aortic valve replacement being 3.1% and for mitral valve replacement 2.9%. Combined aortic and mitral valve replacement had an early mortality of 4.4%. The number of patients undergoing isolated coronary artery bypass grafting has increased from 59 in the first 1000 to 292 in the third 1000 operations, with an overall early mortality of 1.3%. Six hundred and ninety seven patients underwent surgery for congenital heart disease with an overall early mortality of 10.9% (7.5% in the last 2000 cases). The patients have been followed up from one to 8.5 years. A high proportion have returned to work and enjoy a normal life. At the time of review, 87% of the 3000 patients were alive. Long waiting times for outpatient and inpatient care indicate underprovision of facilities relative to regional demand.